Plan K Benefits

Benefit

What Plan K Covers

Part A Deductible
You may need this benefit if you have to stay in the hospital. The Part A deductible for 2013 is $1,216. This amount can change every year. You have to pay this deductible for each benefit period.

Plan K covers 100% of the $1,216 deductible

Part B Deductible
You may want to consider this benefit if you have Medicare Part B. Each year you must pay the Part B deductible (which is $147 in 2013) before Medicare starts to pay its share. If you have this benefit, the Medigap plan would pay this amount each year.

Plan K does not cover the Medicare Part B $147 deductible

Part B Coinsurance
Without this benefit, you generally pay 20% of the Medicare-approved amount for Medicare Part B covered services and supplies (like doctor services and outpatient hospital care). This benefit will help you to reduce your out of pocket after Part B deductible.

Plan K covers 10% of the remaining costs after you pay the $147 Part B deductible

365 Extra Days of Hospital Stay
After you use all Medicare hospital benefits, you can receive up to 365 more days for hospital stays during your lifetime.

Plan K covers all of the costs for an additional 365 additional hospital days

3 Pints of Blood
The first 3 pints of blood or equal amounts of packed red blood cells per calendar year, unless this blood is replaced.

Plan K covers 50% of the costs of 3 pints of blood per calendar year

Part B Excess Charges
Under federal law, doctors who don’t accept “assignment” (take Medicare’s approved amount as payment in full) may charge up to 15% more than the approved amount. You might want to think about this benefit if your doctors don’t accept assignment. You may also want this benefit if you have to stay in the hospital and can’t control whether the doctors you see accept assignment.

Plan K does not covers Part B Excess Charges

Hospice Care
Hospice is a special way of caring for people who are terminally ill and for their families. This care includes physical care and counseling. The goal of hospice is to care for you and your family, not to cure your illness.

Plan K covers 50% of your copay

Foreign Travel Emergency
If you travel outside the United States, this benefit could save you money for emergency care.

Plan K does not cover foreign travel emergencies

Skilled Nursing Coinsurance
Medicare pays for the first 20 days of a skilled nursing facility. If you need to go to a Skilled Nursing Facility (SNF) after a hospital stay and stay in the SNF longer than 20 days, this benefit begins.

Plan K covers up to 50% of $148 per day for days 21-100.

Home Health Care
Home Health Care is skilled nursing care and certain other health care services you get in your home for the treatment of an illness or injury.

Plan K covers 10% of the remainder after the $147 Medicare Part B deductible.

Out of Pocket Limit
The maximum costs you are responsible for in a calendar year.

Plan K will cover 100% of all costs if you reach the $4,640 out of pocket limit

Plan K Rates

The following rates are for Illinois residents living in the following Counties: